Psychopathology Test PERSONALITY DISORDERS

PERSONALITY DISORDERS
Personality Defined
• All emotional and behavioral traits that characterize the person in day-to-day living under ordinary
circumstances
• Enduring patterns of perceiving and relating to/thinking about the environment and oneself, exhibited in wide
range of social and personal contexts - DSM IV
• Requires evaluation of long-term patterns of functioning, distinct from responses to situational
stressors/transient mental states –DSM IV
• Enduring pattern of inner experience and behavior, deviating markedly from expectations of a person’s culture
- DSM IV
• Deviation manifested in at least two areas: cognition, affect, interpersonal functioning, impulse control
• Pattern inflexible and pervasive across a broad range of personal and social situations
Disorder Definition
• Pattern brings significant distress or impairment in social, occupational or other important functional area -
DSM IV
• Pattern stable, of long duration, with onset traced back to adolescence or early adulthood
• Not due to, or manifestation of, another mental disorder, substance disorder, or general medical condition
Classification
• Cluster A - odd and eccentric
○ paranoid
○ schizoid
○ schizotypal
• Cluster B - dramatic, emotional, erratic
○ borderline
○ histrionic
○ antisocial
○ narcissistic
• Cluster C - anxious, fearful
○ Dependent
○ Obsessive-Compulsive
○ Avoidant
○ Not Otherwise Specified (NOS)
Diagnosis
• Must distinguish trait (enduring subthresholdpersonality characteristic) from a temporary state and role
• Understand the concept of pathological threshold (significant impairment in major functional area)
• Assessment: clinical interview; self-report inventory (e.g. MMPI); semistructured interviews (e.g. SCID); third
party info
• Multiple diagnoses may be made, since a large number of patients meet criteria for 2 or more Axis II
syndromes
• Important to list every disorder on Axis II
• If symptoms/signs not severe enough to warrant a disorder diagnosis, personality characteristics my be noted
on Axis II using the term “trait” rather than disorder
Etiology
• Genetic
○ Twin studies support genetic causation
○ Cluster A increased in schizophrenia families
○ Cluster B
 antisocial assoc w/ alcohol dependence
 histrionic assoc w/ somatization disorder
• More physical problem without an
organic reason
• Temperament - “POOR PARENTAL FIT”
• Biologic Factors
○ Antisocial assoc with organic (abnormal EEG, MBD)
○ Low serotonin assoc with depression, impulsivity,
aggression, ruminative thoughts (SSRIs for this)
Personality Psychology
• Defenses
○ Each individual’s unique personality profile is
determined by defenses
○ Each Axis II disorder is a cluster of defenses
○ Effective defenses bring control of mood & function
• Object Relations

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• Interpersonal styles/patterns displayed by key figures or groups/culture early in life are adopted/
internalized; this is called identification
• An individual’s psychology is drawn to repeat these patterns, looking for relationship partners who will
collaborate (usually unconsciously) spontaneously or by induction (through projection, e.g. Santini clip)

Schizoid, Cluster A
“I PASSED” - 4/7
• *Indifference to praise or criticism
• *Pleasure from hobbies/activities absent
• *Activities solitary, no friends/confidants
• *Sexual experiences of no interest
• *Solitary lifestyle by preference
• *Emotionally detached
• *Desire for close relationships lacking
Paranoid
“HUGS FAR” - *4/7
• *Hidden meanings seen in others’ remarks
○ “Idea of reference”
• *Unjustified doubts about others
• *Grudges held
• *Suspects others of exploitation
• *Fidelity of partner doubted
• *Attacks on character suspected
• *Reluctance to confide in others
Histrionic, Cluster B
“I CRAVE SIN” - *5/8
• *Inappropriate behavior: seductive/provocative
• *Center of attention
• *Relationships seen as close when they’re not
• *Appearance is important for attention
• *Vulnerable to suggestions/influence of others
• *Emotional expression is exaggerated/theatric
• *Shifting emotions rapidly and shallow
• *Impressionistic manner of speaking, no details
• *Nice, too nice to be normal
• Histrionic Facts
○ More frequent in women
○ Association with somatization disorder
 (multiple physical complaints w/o organic cause)
○ Association with alcohol use disorders
○ Tendency to repress (forget) affect
○ Female anorgasmia and male impotence increased
Borderline
“AMID A RISE”- *5/9
• *Abandonment frantically avoided
• *Mood instability
• *Identity disturbance (unsure of who they are and
○ their goals in life)
• *Dissociative symptoms & paranoid thoughts
• *Anger poorly controlled and chronic
• *Relationships unstable with splitting
• *Impulsivity that damages
• *Suicidal behavior recurrent
• *Emptiness that’s chronic
• Borderline Facts
○ Short-lived psychoses when stressed
 (Brief Psychotic Disorder)
○ Dependence mixed with hostility
○ Self-destructive acts to avoid loneliness
○ Self-mutilation (cutting forearms/thighs) to relieve anxiety/help with identity issues
○ Projective identification and splitting in relationships
○ Panphobia, pananxiety, chaotic sexuality
Antisocial
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“CALLOUS MAN” - *3/7

• *Conduct disorder <15 y.o., currently >17 y.o.
• *Antisocial acts that are grounds for arrest
• *Lies frequently
• *Lacks remorse
• *Obligations not honored (financial, work etc)
• *Unstable, can’t plan ahead
• *Support lacking for children or spouse
• *Makes no provisions for safety of self/others
• *Aggressive/irritable/assaultive
• *Not occuring during schizophrenia or mania
• Antisocial Facts
○ Common in urban areas
○ Up to 75% of prison populations
○ 5 times more cases in 1st degree relatives of males with this disorder
○ Frequent abnormal EEG’s and neuro signs
○ Lack of appropriate anxiety and depression
○ Abuse in behavior toward families, and in use of alcohol, promiscuous
○ Many have somatization disorder (multiple physical complaints w/o organic cause)
Narcissistic
“FEEDS A GAME” - *5/9
• *Fantasizes about huge success, brilliance, beauty
• *Empathy lacking for others
• *Exploitative
• *Demands to be treated as special
• *Special people are needed to understand him/her
• *Admiration needed in large amounts
• *Grandiose sense of self
• *Arrogant
• *Manipulates others to get compliance
• *Envious of others
Avoidant, Cluster C
“A CIRCUS” - *4/7
• *Avoids occupational activities w/ others
• *Certainty of being liked needed before involved
• *Inhibited when meeting people
• *Restrained within relationships
• *Criticism or rejection is a preoccupation
• *Unusually reluctant to take risks
• *Self-deprecating
Dependent
“NEEDS PUSH” - *5/8
• *Needs others to take responsibility for life
• *Expressed disagreement w/ others is limited
• *Excessive lengths to get nurtured and supported
• *Decision-making is difficult
• *Starting projects independently is difficult
• *Preoccupied with fears of being abandoned
• *Urgently seeks another when relationship ends
• *Self-confidence lacking
• *Helpless when alone
Obsessive-Compulsive
“PERFECTION” - *4/8
• *Preoccupied with rules, details, plans
• *Expression of affect is restricted
• *Reluctant to delegate tasks—do everything themselves
• *Frugal
• *Excessively devoted to work
• *Controls others, can’t delegate
• *Task completion blocked by perfectionism
• *Inflexible, rigid stubborn
• *Overconscientious about ethics, morals, values
• *Not able to discard belongings, hoards objects
• Obsessive-Compulsive Facts
• Increased in men, with diagnosis in late childhood

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• Increased in first degree biologic relatives

• Excessive discipline as children
• Constricted (isolated/walled-off) affect, under stress, affect can emerge suddenly (volcanic) need control, need
detailed answers to questions
• Unable to compromise, need submission

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